In this section
Poisoning – Acute guidelines for initial management
For advice contact the Victorian Poisons Information Centre on 13 11 26 (24 hours a day, seven days a week)
Nicotine is highly toxic and rapidly absorbed after either ingestion or inhalation.
Poisoning occurs through initial stimulation and ultimate blockade of the nicotinic acetylcholine receptor.
Initial stimulatory effects occur within minutes and may include agitation, diaphoresis, nausea and vomiting, tachycardia, bronchoconstriction and seizures. At higher doses, a second phase involving bradycardia, hypotension, respiratory failure and coma may supervene 1 to 4 hours after exposure.
Any ingestion may cause mild toxicity. The minimum potentially lethal dose is reported to be anything greater than 0.5 mg/kg. Any child ingesting more than one whole cigarette or more than three butts requires medical assessment. The quantity of nicotine in various products is shown below.
*note: e-cigarette devices and liquid nicotine solutions remain unregulated in Australia. As such, product labels are unreliable and true nicotine concentrations have been shown to vary widely.
Early clinical signs (<1 hour)
Late clinical signs in larger exposures (1 to 4 hours)
For all symptomatic patients:
Most cases of exposure will be low-risk and management is supportive. For higher-risk exposures, consider:
Ongoing care and monitoring
Patients who are either asymptomatic following exposure or who are recovering from gastrointestinal symptoms only should be monitored for 4 hours prior to discharge.
Admission should be considered for all children with signs or symptoms of a larger exposure and for adolescent patients with an intentional overdose.
Consult Contact Victorian Poisons Information
Centre 13 11 26 for advice
For emergency advice and paediatric or neonatal ICU transfers, call
the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137
Period of observation as above
For deliberate ingestion. A risk assessment should indicate that the patient is at low risk of further self-harm in the discharge setting
Poisoning prevention for children Parent information
Victorian Poisons Information Centre: 13 11 26
Intentional self harm: Referral to local mental health services e.g. Orygen Youth Health: 1800 888 320
Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685